It's like drilling a hole in a wall, and no one can guarantee that it will be able to accurately get through to the point drawn on the opposite side.

It's normal to hit crookedly, to hit off.

What's more, the anastomosis segment of the patient's occlusion is not a little long.

In the event of occlusion, it is relatively less difficult if surgery can be performed as soon as possible. Now that the past few months have passed, the occlusion section has been extended a lot, and it is even more difficult to get through it.

Zhou Can thought hard about the surgical plan.

A bold surgical plan gradually took shape in his mind.

"With the help of endoscopic ultrasound, coupled with X-ray assistance, it may be possible to successfully open the occluded esophagus-jejunal junction. This requires the cooperation of a skilled nurse, and the surgeon who controls the endoscope has superb endoscopic surgery skills and puncture. ”

Needless to say, Zhou Can's endoscopic operation skills are extremely talented and skillful.

Paracentesis is highly similar to injection.

The level of injection is high, and the level of puncture is also strong.

Therefore, Zhou Can personally operated on this patient, and there is no technical obstacle.

It is not difficult to find a skilled nurse to cooperate.

The blockage is opened with an endoscopic ultrasound, which is done by using a thin needle from the anastomosis end of the esophagus to the jejunum. A laminated metal stent is then placed to prop the occluded esophagus into the jejunal anastomosis.

It was successfully opened.

As for the resolution of esophageal anastomotic fistula, conservative treatment is generally preferred when it is not severe.

This patient's condition is so severe that surgical removal of the fistula is the first choice.

Zhou Can went through the patient's surgical plan several times in his mind, and scrutinized and troubled the omissions step by step. Even drawings of the surgical plan were drawn by hand.

After doing all this, all that remains is to ask Director Shang.

If approved, talk to the family.

As long as the family trusts the hospital and agrees to the surgical plan, it can be implemented.

After thinking about it, I waited for Director Shang to arrive.

Chief physicians generally arrive late, and many of them arrive at the department office around 9 o'clock.

He doesn't have any other work at hand anyway, and he is idle when he is idle.

Start looking at other cases in the group.

Remembering that he entered the ward in the morning and saw a patient with bed 73 humming there, he decided to find out about this patient first.

The patient is 51 years old, has a long-term history of drinking, and does not drink every day. This time, because of the unbearable abdominal distension and pain, I was admitted to the hospital for examination. Both ultrasound and x-rays show pancreatic duct stones.

The attending physician is Director Shang, who prescribes endoscopic stone removal for the patient.

Surgery done yesterday.

The pancreaticobiliary sphincter was incised, and the pancreatic duct was dilated and the stone was removed.

The surgery went well.

Both the surgical record and the post-operative care record show that the patient's surgery was successful.

There should be nothing wrong with this patient.

After reading it, Zhou Can continued to look at other cases in this group.

What interests him the most is those incurable diseases.

Each case diagnosed in this case is rewarded with 100 experience points for pathological diagnosis.

Until now, his pathological diagnosis is still at the inferior level.

This medical skill is also the most difficult to upgrade among the many medical skills.

Pharmacological differentiation is also difficult to improve, mainly because there was no prescription right before.

Now that I have obtained the medical license, the right to prescribe, and entered the internal medicine department focusing on drug treatment, the experience value of pharmacological syndrome differentiation will definitely be able to rise.

"Yo, Dr. Zhou came early! It's all early birds that eat worms, and you're so diligent every day, no wonder your medical level is so high. ”

Luo Shengsheng, the chief hospitalist, came back from the ward, and as soon as he entered the office, he saw Zhou Can, who was seriously checking and studying the cases in this group, and immediately greeted him with a smile.

In fact, there are two other interns and a resident doctor in the office of the university.

Luo Shengsheng turned a blind eye to them, but only gave priority to greeting Zhou Can.

It can also be seen that this person is a little inflammatory.

Seeing that Zhou Can's potential is outstanding, and he is directly led by Director Shang, the future is immeasurable. He naturally had to look at Zhou Cangao twice.

In his mind, Zhou Can's status even surpasses that of ordinary residents.

"Mr. Luo, don't praise me! Compared to your predecessors, I'm nothing at all. Besides, isn't there another saying that the early worm is eaten by the birds. I came early, maybe I had a tricky patient, and it was very likely that I would be abused and couldn't find the north. ”

Zhou Can responded with a smile.

"Haha! Dr. Zhou's thinking is really unusual. It's the first time I've heard of this kind of reverse thinking that early insects are eaten by birds. Speaking of tricky patients, I really met one, the patient in bed 13 had a few near-misses last night, and this morning it was from six o'clock to now, and it almost didn't make me collapse. By the way, is Dr. Chi here? ”

Luo Shengsheng talked about the patient, with a sad face, and he looked unlucky.

It's hard to laugh.

Sometimes, whether they are residents, interns, or trainees, they will avoid those difficult patients as much as possible.

Because everyone is afraid of getting into trouble.

Luo Shengsheng is the general hospital, and he is on duty all year round, so he can't hide from this kind of thing.

However, being hospitalized is always the only way to become a doctor.

It can be seen as a grind.

It's really workouting.

After a year of exercise, many residents are reborn.

They can benefit a lot from the ability to stand alone, the ability to respond to the rescue of critically ill patients, and the ability to face various emergencies, such as a sharp decline in patients' physical signs and family troubles.

The tricky patient that Luo Shengsheng encountered was probably the patient in charge of Dr. Chi.

Otherwise, I wouldn't have asked that.

"When I came, I only saw the three of them, not Dr. Chi." Zhou Can came very early.

"Oh! That should arrive a little later. I'd better write the course of the disease first! ”

Luo Shengsheng sat down in front of the computer and began to write about the course of his illness.

Not long after, Dr. Xia Ping walked into the office with Dr. Chi.

The two seemed to be in a good mood, chatting and laughing all the way into the office.

"Doctor Chi, the patient in bed 13 almost had a big incident this morning. Since 11 o'clock last night, the patient's condition has not been very good. I thought about you after a tiring day, and as long as it wasn't dangerous enough for me to handle, I couldn't disturb you. In one night, I rescued him six times and never closed my eyes once. ”

Luo Shengsheng is not only complaining, but also asking for credit.

After working all night, he naturally wanted to let Dr. Chi know.

"It's so hard for you! I'll go over and have a look. ”

Dr. Chi put down his bag, went into the room to change into his work clothes, and quickly rushed to the ward to check on the patient's condition.

As the start of the day approaches, more and more doctors are entering the office.

Zhou Can is just a regular trainee, just one day after entering the Department of Gastroenterology, and his status is a little bit, which is not stable.

Seeing so many doctors coming in, he was very interested, quit his account, stood up, and gave up his seat.

He is just as interested in other trainees and interns.

Everyone is very self-aware, and no one will compete for a seat with a senior doctor.

Some people may not know how low the status of interns is.

There wasn't even a hook to hang clothes on.

As for arranging a fixed seat for interns or trainees in the office, it is a desire to eat fart.

The doctors work in different shifts, and so many doctors come today, filling the office, which makes Zhou Can feel extremely puzzled.

Is there a family member who wants to make trouble, and the department got the news and called all the doctors over in advance to suppress the scene?

No hospital can avoid family troubles.

As long as there are things that they think are unreasonable, he dares to make trouble.

Some things are quite normal for B's family to beat nurses and doctors.

When encountering such family members, doctors and nurses want to say that they are not stunned, it is false.

It's basically hiding.

Zhou Can saw that the senior residents in some departments had no seats to sit on, so they could only stand like them.

Those who can sit are at least at or above the level of the main director.

"Hah, it's early! Inform me and get ready for a morning meeting in the big conference room. ”

As soon as Director Shang entered the office, his aura was strong enough to crush everyone.

What was originally a noisy and noisy office suddenly became quiet.

Zhou Can patted his head, and then remembered that yesterday, Dr. Xia Ping and Dr. Zhang, who was in charge of the bed, almost caused a medical accident. Director Shang mentioned at that time that he was going to have a morning meeting today to emphasize medical safety.

No wonder all the gastroenterology doctors are here.

Doctors walked out of the office and headed to the conference room.

You can see that some nurses and girls are also walking towards the conference room in groups.

It seems that this is a morning meeting held by the whole department.

Tuya Hospital is still very strict in the area of medical safety.

"Dr. Zhou, how is the patient with esophageal jejunostomy fistula?"

Director Shang stopped Zhou Can.

Duan Zifu and Yu Xin, who were in the same group, looked at Zhou Can together.

There was a hint of envy in his eyes.

The only person who can make Director Shang so attentive is Zhou Can.

Neither of them had such treatment as Zhou Can.

"The patient's physical signs are quite stable, this is a surgical plan I have formulated, there may be immature places, please have time to help take a look."

Zhou Can has long drawn the surgical plan into the most intuitive drawing.

In this situation, Director Shang obviously didn't have time to listen to his detailed report.

It is quick and convenient to hand over the drawings to Director Shang.

"You also drew surgical drawings?"

Director Shang took it and glanced at it twice, and a shocked expression suddenly appeared on his face.

"The lads are not only doing a solid job, but they are also very detailed, which is very good. The surgery plan is similar to what I expected, which shows that you really put your heart into it. ”

A satisfied smile bloomed on Director Shang's face.

The doctors who passed by couldn't help but look at Zhou Can twice.

I all know that there is a strong doctor in the department. But many people don't know Zhou Can yet, nor do they know his strength.

Now seeing Director Shang praising Zhou Can with a smile, they looked at Zhou Can a few times.

Even Yu Xin, the cold female doctor of Guipei, also looked at Zhou Can seriously for the first time.

After training under Director Shang for so long, she knows very well how difficult it is to get Director Shang's praise.

"Thank you for your affirmation of me. I checked the patient's previous examination data and diagnosis records at other hospitals, and although the patient had an esophageal anastomotic leak, he had never had an intra-abdominal infection. However, after the first operation, he ate and missed something, indicating that the anastomotic leakage was very serious. I think removing the fistula is just a better solution. ”

Zhou Can took the opportunity to raise his own questions.

"Hehe, this question is very thoughtful! After the morning meeting, I will discuss it with you in detail. It's a great attitude that you can ask patients about their visits to other hospitals and conduct in-depth and detailed research. I was also very satisfied with your first day of work. Let's go to the meeting first! ”

When Director Shang looked at Zhou Can, his eyes were full of appreciation.

There is no vanity under the fame.

Zhou Can can be appreciated and loved by so many chief physicians, and he really has a lot of outstanding features.

"Okay!"

Zhou Can walked a few steps quickly, caught up with Duan Zifu and Yu Xin, and went to the conference room together.

Everyone is a regular trainee in the same group, and it is natural to sit together in a meeting.

"Dr. Zhou is amazing! After only one day of training, he was highly affirmed and praised by Director Shang. You know, I trained for nearly a month before I got shit luck, and I was appreciated by Director Shang, who transferred me to him. ”

Trainees who can follow the chief physician generally have some strength.

Duan Zifu's strength should not be weak.

"I don't dare to compare with you, that is, I just do a solid job."

Zhou Can said modestly.

"I heard that Dr. Zhou's ability to diagnose and operate is very strong, can you help Dr. Yu?" Duan Zifu's words changed sharply and made a small request.

Yu Xin's face was expressionless, and she didn't speak.

Only Xiu Mei frowned slightly.

It seems that this is a tricky thing to do.

"Let's talk about it first, what's the matter? My ability is also very limited, and I may not be as good as you, and I may not be able to help if I want to. ”

Zhou Can did not directly refuse.

"That's right, the 73-bed patient managed by Dr. Yu had pancreatic duct stone removal surgery yesterday, and when I went to the ward round this morning, I found that the patient had been complaining of stomach pain. And the body temperature has also increased. However, after checking, the cause could not be found. ”

Duan Zifu told the general situation.

"Isn't it the normal pain of waking up from anesthesia after surgery?"

Zhou Can has a lot of experience in surgery, and the total number of surgeries he has done is much more than that of ordinary attending physicians.

He also has extensive experience in postoperative management.

"It shouldn't be postoperative pain. This is because the pain is not the surgical site, but the lower abdomen. In addition, the patient has symptoms of nausea. There is also an increase in body temperature. ”

Yu Xin took the initiative to answer Zhou Can's question.

It seems that she is thin-skinned and it is difficult to open her mouth to Zhou Can.

Now that Duan Zifu has opened her mouth, she has not maintained the so-called coldness anymore.

When encountering such a tricky patient, she can't help but worry.

In case something happens because of her inadequate management, it will definitely affect her future.

"Didn't you report it to the senior doctor?"

Zhou Can asked again.

She hesitated for a moment, then finally bit her lip and said with some embarrassment, "There is an unwritten rule for the competition between doctors in our group. Reporting a small matter to a senior doctor can be considered a sign of incompetence. This will be minus points in Director Shang's heart. I want to fight for the opportunity to follow Director Shang for consultation and surgery, and if this problem can be solved by myself, I want to solve it by myself. ”

Wealth and danger are sought.

The competition among junior doctors is sometimes very delicate.

Just like the patient managed by Zhou Can, he formulated a complete set of surgical plans by himself, which must be a big plus in Director Shang's mind.

If you report a big thing to a senior doctor, you will be labeled as a 'giant baby'.

It is estimated that no good doctor wants to be labeled as such.

But her strength is not enough, she doesn't report this matter, and she is worried that something will happen.

That's more than worth the loss.

The delicate balance can only be grasped by oneself.

Thank you book friends, voice-activated pharaoh king for your tipping support.

(End of chapter)